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Surgical Management of Symptomatic Apical Pelvic Organ Prolapse: A Systematic Review and Meta-analysis.

Obstet Gynecol 2021 May 4. Epub 2021 May 4.

Department of Obstetrics and Gynecology, McGill University, and St. Mary's Research Centre, Montreal, Québec, and the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.

Objective: To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP).

Data Sources: MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002-2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English. Read More

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Reproductive Diseases and Disorders of Female Camels: An Assessment and Pathological and Bacteriological Study in Eastern Ethiopia.

Vet Med Int 2021 13;2021:6641361. Epub 2021 Feb 13.

Haramaya University College of Veterinary Medicine, P.O. Box 138, Dire Dawa, Ethiopia.

Camels are the most efficient domesticated animals in arid and semiarid areas of the world. In Ethiopia, they are the main livestock kept to sustain the livelihoods of pastoralists, as camels are used for milk and meat production and also for transportation. However, she-camel reproductive diseases are one of the major constraints for camel-producing communities. Read More

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February 2021

A life-threatening condition - ruptured ectopic pregnancy with negative urine pregnancy test: A case report.

Malays Fam Physician 2021 Mar 1;16(1):121-123. Epub 2021 Feb 1.

MD (UPM), MMed Family Medicine (UPM), Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.

Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Read More

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Risk of obstetric anal sphincter injury with fundal pressure in second stage of labor: Transperineal ultrasound study.

Neurourol Urodyn 2021 May 4. Epub 2021 May 4.

Department of Obstetrics and Gynecology, Medicalpark Göztepe Hospital, Istanbul, Turkey.

Aims: Clinical management of the second stage of labor and effectiveness of preventive measures for severe perineal tears are controversial. The aim of this study was to evaluate the effect of using uterine fundal pressure during the second stage of delivery on obstetric anal sphincter injury (OASI), among primiparous women using three-dimensional (3D) transperineal ultrasonography.

Methods: A total of 73 women who had their first vaginal birth were included in the study, the fundal pressure group included women where the fundal pressure maneuver was applied (n = 37); and the control group included women who delivered spontaneously without fundal pressure (n = 36). Read More

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Integrating Option Grid Patient Decision Aids in the Epic Electronic Health Record: Case Study at 5 Health Systems.

J Med Internet Res 2021 May 3;23(5):e22766. Epub 2021 May 3.

Dartmouth College, Lebanon, NH, United States.

Background: Some researchers argue that the successful implementation of patient decision aids (PDAs) into clinical workflows depends on their integration into electronic health records (EHRs). Anecdotally, we know that EHR integration is a complex and time-consuming task; yet, the process has not been examined in detail. As part of an implementation project, we examined the work involved in integrating an encounter PDA for symptomatic uterine fibroids into Epic EHR systems. Read More

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The assessment of the relationship between the vascularity of FIGO Type 4-7 leiomyomas and abnormal uterine bleeding.

J Obstet Gynaecol 2021 May 3:1-5. Epub 2021 May 3.

Department of Obstetrics and Gynecology, Faculty of Medicine, Ufuk University, Ankara, Turkey.

The current study aimed to analyse and compare the vascularity of FIGO Type 4-7 leiomyoma specimens obtained from women with or without abnormal uterine bleeding (AUB). The records of 31 women who underwent myomectomy for FIGO Type 4-7 leiomyomas in a university hospital setting were analysed. Group I ( = 16) was composed of women that were symptomatic for AUB and group II ( = 15) consisted of asymptomatic cases. Read More

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CT scan assessment of intrauterine balloon tamponade failure for the treatment of atonic postpartum hemorrhage: implications for treatment.

BJOG 2021 May 3. Epub 2021 May 3.

Department of Gynecology and Obstetrics, Kyoto University, Kyoto, 606-8507, Japan.

Uterine atony is one of the leading causes of maternal death, and the use of intrauterine balloon tamponade is recommended for the treatment of atonic postpartum hemorrhage. The success rate of balloon tamponade for uterine atony is high, but some cases with atonic postpartum hemorrhage require arterial embolization or hysterectomy. Therefore, it is important to understand the underlying causes of refractory atonic postpartum hemorrhage and the limitations of balloon tamponade to choose an appropriate treatment for atonic postpartum hemorrhage. Read More

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ZBTB28 induces autophagy by regulation of FIP200 and Bcl-XL facilitating cervical cancer cell apoptosis.

J Exp Clin Cancer Res 2021 Apr 30;40(1):150. Epub 2021 Apr 30.

Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong District, China.

Background: Among the common preventable cancers of women, cervical cancer has the highest morbidity. It is curable if detected at an early stage. However, reliable diagnostic and prognostic markers, which relate to physiologic and pathologic regulation of cervical cancer, are not available. Read More

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Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids-Efficiency Assessment with the Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging and the Potential Role of the Administration of Uterotonic Drugs.

Diagnostics (Basel) 2021 Apr 16;11(4). Epub 2021 Apr 16.

Department of Gynecological Oncology and Gynecology, Medical University of Lublin, 20-081 Lublin, Poland.

Objective: The assessment of the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) when qualifying patients with uterine fibroids (UFs) for magnetic resonance-guided high-intensity ultrasound (MR-HIFU).

Material And Methods: This retrospective, single center study included 283 women who underwent DCE-MRI and were treated with MR-HIFU. The patients were divided according to non-perfused volume (NPV) as well as by the type of curve for patients with a washout curve in the DCE-MRI study and patients without a washout curve. Read More

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Flow Cytometric Assessment of the Viability and Functionality of Uterine Polymorphonuclear Leukocytes in Postpartum Dairy Cows.

Animals (Basel) 2021 Apr 10;11(4). Epub 2021 Apr 10.

Department of Reproduction, Obstetrics and Herd Health, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium.

Postpartum dairy cows experience impaired peripheral polymorphonuclear leukocyte (PMN) functionality, which has been associated with reproductive tract inflammatory diseases. However, it has not been elucidated yet whether endometrial PMN functionality is (equally) impaired. We developed a method for endometrial PMN isolation and flow cytometric assessment of their viability and functionality. Read More

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Inter-observer agreement of transvaginal ultrasound and magnetic resonance imaging in local staging of cervical cancer.

Ultrasound Obstet Gynecol 2021 Apr 29. Epub 2021 Apr 29.

Department of Clinical Science and Education, Karolinska Institutet and Department of Obstetrics and Gynecology Södersjukhuset, 11883, Stockholm, Sweden.

Objectives: To evaluate the inter-observer agreement in relation to observer experience for the assessment of local tumor extension in women with cervical cancer, using transvaginal ultrasound (US) and magnetic resonance imaging (MRI).

Methods: The observers comprised six US specialists with, and seven without previous experience of cervical cancer assessment, five experienced radiologists in pelvic MRI, and four less experienced radiology residents without previous MRI experience. The less experienced US observers, and all MRI observers underwent comprehensive training on assessment of cervical tumor extension while experienced US observers received written directives. Read More

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Physiology and Pathology of Contractility of the Myometrium.

In Vivo 2021 May-Jun;35(3):1401-1408. Epub 2021 Apr 28.

Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece.

Uterine atony is a serious obstetrical complication since it is the leading cause of postpartum hemorrhage. Postpartum hemorrhage (PPH) is one of the 5 major causes of postpartum mortality; therefore, it requires immediate medical intervention, independent of whether delivery occurs normally or with a cesarean section. While in the past years most cases of postpartum hemorrhage were caused due to uterine atony following vaginal delivery, in recent years most PPH cases indicate a significant association with cesarean delivery. Read More

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Cold scissors versus electrosurgery for hysteroscopic adhesiolysis: A meta-analysis.

Medicine (Baltimore) 2021 Apr;100(17):e25676

Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University.

Background: Intrauterine adhesion seriously affects reproductive health in women. Hysteroscopic adhesiolysis using cold scissors or electrosurgery is the main treatment, although there is no consensus on the preferable method. This review aimed to compare the efficacy and safety of these methods for treating moderate to severe intrauterine adhesion. Read More

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Doppler ultrasound in pregnancy - quality requirements of DEGUM and clinical application (part 2).

Ultraschall Med 2021 Apr 27. Epub 2021 Apr 27.

Obstetrics and Prenatal Medicine, University Hospital, Bonn, Germany.

This second part on Doppler sonography in prenatal medicine and obstetrics reviews its clinical applications. While this has not become the initially anticipated screening tool, it is used for the diagnosis and surveillance of a variety of fetal pathologies. For example, the sonography-based determination of uterine artery blood flow indices is an important parameter for the first trimester multimodal preeclampsia risk assessment, increasing accuracy and providing indication for the prophylactic treatment with aspirin. Read More

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Morphological changes in bitches endometrium affected by cystic endometrial hyperplasia - pyometra complex - the value of histopathological examination.

BMC Vet Res 2021 Apr 26;17(1):174. Epub 2021 Apr 26.

Department of Diagnostics and Clinical Sciences, Institute of Veterinary Medicine, Nicolaus Copernicus University in Torun, Toruń, Poland.

Background: Cystic endometrial hyperplasia-pyometra complex (CEH-P) is one of the most common uteropathies in bitches. In diseases with mild or obscure clinical signs and normal uterine size, a diagnosis based on a clinical assessment might be incorrect. The main aim of the research was to determine the morphological variables accompanying uterine diseases in bitches in microscopic evaluation. Read More

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The impact of adenomyosis on IVF outcomes: a prospective cohort study.

Hum Reprod Open 2021 19;2021(2):hoab015. Epub 2021 Apr 19.

Newlife IVF, Box Hill, VIC, Australia.

Study Question: Does the presence of adenomyosis in women treated with IVF alter IVF outcomes?

Summary Answer: Adenomyosis does not significantly alter IVF outcomes when adjusted for confounding factors including maternal age and smoking status.

What Is Known Already: Studies evaluating adenomyosis and its impact on infertility, particularly when focusing on IVF, remain controversial. Many studies report that adenomyosis has a detrimental effect on IVF outcomes, however age is strongly related with both the prevalence of adenomyosis and worse reproductive outcomes. Read More

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Long Term Follow-up of Endometriosis Surgery in Ontario: A Population-Based Cohort Study.

Am J Obstet Gynecol 2021 Apr 21. Epub 2021 Apr 21.

Department of Obstetrics and Gynaecology, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada; ICES, Queen's University, Kingston, ON, Canada.

Objective: To characterize the long term outcomes, including recurrence of symptoms, fertility outcomes and need for reoperation, of patients undergoing surgical management of endometriosis.

Methods: Population-based cohort study using universal coverage health database for the province of Ontario, Canada of women aged 18 to 50 undergoing surgery for endometriosis from April 1, 2002 through March 31, 2018. Surgery was classified as diagnostic laparoscopy, conservative/uterine preserving (minor or major, with and without ovarian preservation) and hysterectomy (with and without ovarian preservation). Read More

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A Systematic Review of the Treatment of Uterine Fibroids Using Transcervical Ultrasound-Guided Radiofrequency Ablation with the Sonata® System.

J Minim Invasive Gynecol 2021 Apr 20. Epub 2021 Apr 20.

Department of Gynecology, Obstetrics and Gynecologic Endocrinology, Kepler University Hospital, Johannes Kepler University, Linz, Austria.

Objective: To evaluate the treatment success, possible side effects, and safety of radiofrequency ablation with the Sonata® System.

Data Sources: An electronic literature search in the PubMed and MEDLINE database was carried out from inception to August 2020.

Methods Of Study Selection: The review was performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Read More

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Critical Role of 3D ultrasound in the diagnosis and management of Robert's uterus: a single-centre case series and a review.

Facts Views Vis Obgyn 2021 Mar 31;13(1):41-49. Epub 2021 Mar 31.

Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany.

A septate uterus with a non-communicating hemicavity was first described by Robert in 1969/70 as a specific malformation of the uterus. The condition is commonly associated with a blind uterine hemicavity, unilateral haematometra, a contralateral unicornuate uterine cavity and a normal external uterine fundus. The main symptoms are repetitive attacks of pain at four-weekly intervals around menarche, repeated dysmenorrhea, recurrent pregnancy loss and infertility. Read More

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Maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation in Ethiopia: A systematic review and meta-analysis.

PLoS One 2021 22;16(4):e0245977. Epub 2021 Apr 22.

Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.

Background: Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation. Read More

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Clinical management of chemotherapy for elderly gynecological cancer patients.

J Obstet Gynaecol Res 2021 Apr 21. Epub 2021 Apr 21.

Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan.

Aim: Since there are no established guidelines for the treatment of gynecological cancer in the elderly, medical treatment policy is currently decided by discussion with patients and their families based on doctors' experiences, referring to data from nonelderly patients and healthy elderly patients. The aim of this review was to clarify the current position of chemotherapy for elderly gynecological cancer patients and discuss the problems to be addressed in the future.

Methods: Little evidence has been accumulated for anticancer drug treatment in elderly individuals with gynecological cancer. Read More

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Management of women with uterine fibroids in reproductive center: retrospective analysis of clinical and reproductive outcomes.

Minerva Obstet Gynecol 2021 Apr 20. Epub 2021 Apr 20.

Reproductive Physiopathology and Andrology Unit, Sandro Pertini Hospital, Rome, Italy.

Background: Uterine fibroids are the most common benign tumor in women. According to literature, submucosal myomas have a negative effect on reproductive outcomes in women undergoing assisted reproductive techniques (ART) but there are fewer data concerning intramural fibroids. During last years, Ulipristal acetate (UPA) 5 mg was widely used as medical option of fibroid's treatment, but from 2020, the Pharmacovigilance Risk Assessment Committee (PRAC) has revoked the marketing authorisation after some cases of liver toxiciy. Read More

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Effects of 3D image-guided brachytherapy compared to 2D conventional brachytherapy on clinical outcomes in patients with cervical cancer: A systematic review and meta-analyses.

Brachytherapy 2021 Apr 15. Epub 2021 Apr 15.

Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.

Purpose: To assess the effects of three-dimensional image-guided brachytherapy (3D BT) compared to bi-dimensional BT (2D BT) on clinical outcomes in patients with cervical cancer.

Methods And Materials: We searched PubMed/MEDLINE, EMBASE, Scopus, CENTRAL, Web of Science, and LILACS for studies assessing the effects of 3D BT versus 2D BT on clinical outcomes. Two reviewers independently screened retrieved citations, extracted data and assessed risk of bias from eligible studies. Read More

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Pyometra-associated insulin resistance assessment by insulin binding assay and tyrosine kinase activity evaluation in canine muscle tissue.

Domest Anim Endocrinol 2021 Mar 23;76:106626. Epub 2021 Mar 23.

Laboratório de Metabolismo e Endocrinologia Comparada, Departamento de Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Sarmento Leite 500, Porto Alegre - RS, Brazil. CEP: 90050-170.

Diestrus is associated with insulin resistance in bitches and pyometra can further impair insulin sensitivity. This study aimed to compare insulin sensitivity, insulin binding, and tyrosine kinase activity in bitches in anestrus, diestrus, or with pyometra. Patients submitted to elective ovariohysterectomy were divided into anestrus (n = 11) or diestrus (n = 13) according to reproductive history, vaginal cytology, and uterine histology. Read More

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Doppler studies of placental function.

Placenta 2021 Apr 2;108:91-96. Epub 2021 Apr 2.

Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, And Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.

Placental-associated diseases account for most cases of adverse perinatal outcome in developing countries. Doppler evaluation has been incorporated as a predictive parameter at early pregnancy for high-risk placental disease, in the diagnosis and management of those fetuses with impaired intrauterine growth and for the evaluation of fetal wellbeing in those high-risk pregnancies. Uterine Doppler at second trimester predicts most instances of early-onset preeclampsia and intrauterine growth restriction. Read More

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The impact of sentinel lymph node sampling versus traditional lymphadenectomy on the survival of patients with stage IIIC endometrial cancer.

Int J Gynecol Cancer 2021 Apr 14. Epub 2021 Apr 14.

Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Objective: To investigate the survival of patients with lymph node positive endometrial carcinoma by type of surgical lymph node assessment.

Methods: Patients diagnosed between January 2012 and December 2015 with endometrial carcinoma and uterine confined disease and nodal metastases on final pathology who underwent minimally invasive hysterectomy were identified in the National Cancer Database. Patients who had sentinel lymph node biopsy alone or underwent systematic lymphadenectomy were selected. Read More

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Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018.

Eur Radiol 2021 Apr 14. Epub 2021 Apr 14.

Department of Radiology, University of Montpellier, Montpellier, France.

Objectives: The recommendations cover indications for MRI examination including acquisition planes, patient preparation, imaging protocol including multi-parametric approaches such as diffusion-weighted imaging (DWI-MR),  dynamic contrast-enhanced imaging (DCE-MR) and standardised reporting. The document also underscores the value of whole-body 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) and highlights potential future methods.

Methods: In 2019, the ESUR female pelvic imaging working group reviewed the revised 2018 FIGO staging system, the up-to-date clinical management guidelines, and the recent imaging literature. Read More

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Descriptive statistics of dataset from the meta-analysis and meta-regression analysis on prognostic significance of pre-treatment systemic hemato-immunological indices of cervical cancer patients.

Data Brief 2021 Apr 3;35:106925. Epub 2021 Mar 3.

Department of Obstetrics and Gynecology, Daping Hospital (Army Medical Center of PLA), Army Medical University, #10 Changjiang Branch Road, Yuzhong District, Chongqing 400038, People's Republic of China.

In this study, we perform a meta-analysis and meta-regression analysis for the article entitled "Prognostic value of systemic hemato-immunological indices in uterine cervical cancer: A systemic review, meta-analysis, and meta-regression of observational studies." [1] We implemented quantitative meta-analyses and time series meta-regression analysis to determine whether systemic hemato-immunological indices, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), thrombocyte-to-lymphocyte ratio (TLR), and C-reactive protein/albumin ratio (CAR) are associated with an increased risk of cervical collision cancer. In all, 9558 patients from 22 studies were included after a systematic data search, performed comprehensively using the following databases: MEDLINE, Web of Science, Embase, and Cochrane. Read More

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Unexplained infertility categorization based on female laparoscopy and total motile sperm count, and its impact on cumulative live-births after one in-vitro fertilization cycle. A retrospective cohort study involving 721 cycles.

Reprod Med Biol 2021 Apr 1;20(2):190-198. Epub 2021 Feb 1.

Centre of IVF and Human Reproduction Institute of Obstetrics and Gynaecology Sir Ganga Ram Hospital New Delhi India.

Purpose: To determine how subcategorizing unexplained infertility based on female laparoscopy and total-motile-sperm-count assessment would impact cumulative live-births after one in-vitro fertilization (IVF) cycle.

Methods: Seven hundred twenty one IVF cycles from Jan 2014-April 2019 performed at a single-center were retrospectively analyzed. Couples with unexplained infertility having normal uterine and endometrial morphology were subcategorized into three cohorts, UI (1): those with no tuboperitoneal pathology on laparoscopy and total-motile-sperm-count (TMSC) ≧20 million: n = 103; UI (2): tuboperitoneal pathology on laparoscopy or TMSC <20 million, n = 86; and UI(3): tuboperitoneal status not known: n = 114. Read More

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Virtual hysterosalpingography: A new non-invasive tool for the assessment of uterine cavity and fallopian tubes.

Eur J Radiol 2021 Apr 2;139:109688. Epub 2021 Apr 2.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil; Medical Course, Municipal University of São Caetano do Sul(USCS), Bela Vista Campus, São Paulo, SP, Brazil. Electronic address:

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